A Woman Undergoes Multiple Complicated Surgeries and Scarring due to a Missed Diagnosis of Ruptured Appendix

Our client, a 41 year old female, presented to the emergency department with complaints of abdominal pain associated with nausea and vomiting. She rated her pain at "20" on a 0-10 scale. Our client was seen in the emergency room by a nurse practitioner. It was recorded by the nurse practitioner that our client had abdominal cramping, vomited 6-7 times, chills, was sweating, and had been urinating less. Upon physical examination, it was found that she had tenderness of the abdomen, with hyperactive bowel sounds. During this examination there is no documentation that appendicitis was in the differential diagnosis or that her abdomen was checked for guarding or rebound tenderness. Minimal testing was ordered; these tests included a CBC, Urinalysis, and P15. There were no radiological studies ordered or performed. Despite her complaints of excruciating pain, our client was not given pain medication until more than two and a half hours after her initial consultation with the nurse practitioner. About 3 hours after her initial arrival, our client received prescriptions for Macrobid and Zofran and was discharged with the diagnosis of a urinary tract infection. At the time she was discharged, she still was experiencing significant pain.

Two days later our client returned to the emergency room with complaints of abdominal pain and tenderness. A CT scan was ordered and the radiologist who read the scan indicated that the findings were compatible with appendicitis with presumed rupture and abscess formation. A surgery consult was made with a general surgeon, and our client was admitted to the intensive care unit at the hospital. An exploratory laparotomy was performed wherein our client was found to have an intra-abdominal abscess with perforated necrotic appendix and associated diffuse peritonitis. Examination of her abdominal cavity revealed extensive exudates on the surface of the small and large bowel. Examination of her cecum revealed the area of the appendix that was necrotic. A resection of the terminal ileum and cecum was performed. After the surgery, our client returned to the ICU where her blood pressure dropped. She required Hespan to maintain a stable blood pressure. Two days later a second surgery was performed on our client where a peritoneal irrigation was done, cultures were taken, and a side to side ileocolostomy was performed. Following this surgery, our client developed respiratory failure with sepsis and required a mechanical ventilation machine for about 24 hours. She remained in the hospital for another 6 days before being discharged.

Our client had to undergo multiple extensive surgeries, a lengthened hospital stay, and great pain and suffering. When our client initially presented to the ER, her symptoms and the results of her test did not correlate well to the diagnosis of a UTI. The nurse practitioner did not perform a proper physical examination, did not order the proper tests, and failed to include appendicitis in the differential diagnosis. If the initial ER nurse practitioner had performed a proper examination and ordered the proper testing, then our client would not have had to undergo the extensive surgeries and extended care.

Consequently, our client was permanently injured and cannot participate in the activities that she once enjoyed. Before the incident, our client enjoyed staying fit by running and working out. She can no longer complete these activities as she experiences pain in the area of her scar. Furthermore, our client is at a heightened risk for adhesions, and that risk increases with every year. Our client's life has been completely changed due to the negligence of the initial nurse practitioner. What should have been a simple surgery with a very quick recovery time was turned into a month long process of complicated surgeries and extended recovery periods. Todd Townsley was able to reach a satisfactory settlement for this client's injury.

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